The News Media and “Entitlement Reform”

In the coming debate about the deficit, policymakers will struggle to craft a package of spending reductions and new revenues that both Democrats and Republicans can agree on, totaling as much as four trillion dollars over ten years. Medicare, Medicaid and potentially the Affordable Care Act will have their turn on the operating table as policymakers look for savings. It is unclear what reductions in Medicare and Medicaid spending policymakers will be able to agree on but whatever they do they will call it “entitlement reform”. Like calling a new tax a revenue enhancement, calling spending cuts and program changes “reforms”, and even better “entitlement reforms”, makes them sound more palatable and forward thinking. News organizations should resist mimicking labels like “entitlement reform” although understandably, policymakers and advocates will use them.

The dictionary defines reform as “to improve, remove faults or abuses, habilitate, reclaim or redeem”. You can see why there would be disagreement about applying that term in the current budget debate.

I was very involved in the welfare reform movement. Surely that was “reform”. Well, maybe. The essential purpose of welfare reform was to transform the welfare system from an emphasis on cash assistance to work. Whether you were for or against welfare reform there was no question that it fundamentally changed the welfare system. Most observers agree welfare reform has been a success and has moved welfare policy in a much better direction. But not everyone shares that view and welfare reform has more than its share of critics. They don’t think it is reform at all. They see it as punitive, leading too often to low-paying jobs. Welfare “overhaul” would have been a much more neutral description but I admit that when I was selling my welfare reform program in New Jersey and helping promote national legislation, I was more than happy to have the media call it reform.

What about “health reform”? It is clear that the law makes fundamental changes to the health insurance and health care systems and will do a great deal of good, but there is obvious and sharply partisan disagreement about whether the law overall is a good thing or a bad thing. For this reason it is the policy at NPR to avoid using the “health reform” label (and along with it the more pejorative Obamacare). This is the practice at our Kaiser Health News as well.

What then about “entitlement reform” in the context of the current budget debate? There will be a long list of reductions in Medicare and Medicaid spending considered as this debate unfolds, from straightforward cuts such as reducing payments to hospitals and nursing homes, to changes in the rules of these two big entitlement programs such as rolling back the age of eligibility for Medicare, income relating Medicare premiums, or converting the Medicaid program to a per capita cap. Each of these will have advocates and opponents and many of these proposals will be hotly debated. All can appropriately be called “entitlement cuts”, or “spending reductions”, or “changes to entitlement programs”. Some proposals – premium support for Medicare, a Medicaid block grant or per capita cap – will rise to the level of an “entitlement overhaul” or “restructuring”. But whether a change is “reform” or good or bad will be in the eye of the beholder. Is premium support a badly needed reform that will introduce fiscal discipline and market competition to the Medicare program as conservatives believe, or a backhanded way to cap federal spending, reduce the role of the federal government and end the Medicare entitlement, which is how many liberals view it? Is a Medicaid block grant a way to give states more flexibility they have long wanted, or to sharply reduce federal funding to the states and eliminate the Medicaid entitlement under the guise of giving states greater flexibility? Is raising the age of Medicare eligibility a reform whose time has come or a way to shift costs from Medicare to seniors and employers? As we begin this new budget debate there is substantial agreement on the need to reduce spending but no agreement on what constitutes “reform” or on which “reforms” are the right ones to make.

Taking an insider debate with mind numbing numbers and complex policy options and making it understandable for the American people is always a huge challenge for the news media. That challenge will take on new importance in the upcoming budget debate. It is understandable that policymakers and advocates would frame what they believe in or have concluded is the best budget tradeoff to make in the most positive light, but calling every spending reduction a “reform” can obfuscate the hard choices that need to be made. Let’s hope the news media will avoid loaded labels and help the public understand the consequences of different approaches to deficit reduction.